Pigeot Iris, Baranowski Tom, Lytle Leslie, Ahrens Wolfgang
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Fachbereich 03: Mathematik und Informatik, Universität Bremen, Achterstr. 30, 28359, Bremen, Deutschland.
USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Nov;59(11):1423-1431. doi: 10.1007/s00103-016-2449-x.
Despite careful planning and implementation, overweight/obesity prevention interventions in children and adolescents typically show no, inconsistent or merely weak effects. Such programs usually aim at behavior changes, rarely also at environmental changes, that draw upon conventional wisdom regarding the commonly accepted determinants of childhood overweight/obesity.
This paper evaluates the evidence base of the apparently overweight-/obesity-related determinants diet, physical activity and stress. The results of international intervention studies are discussed against this background.
Based on the mediating-moderating variable model, we investigate the effect of theory specified mediating variables and how potential moderating variables may impact these relationships.
Contrary to common beliefs, recent research has revealed inconsistent evidence regarding associations between potentially obesogenic behaviors and overweight/obesity in youth. Moreover, the evidence for strong and causal relationships between mediating variables and targeted behaviors seems to be inconsistent. In addition, inadequate attention is paid to moderating effects.
The etiology of overweight/obesity in youth is likely the result of a complex interplay of multi-causal influences. Future prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and of the mechanisms of suspected behaviors for affecting overweight/obesity. Only if substantial change can be demonstrated in mediators with reasonable effort under real world circumstances, it will make sense to progress to community behavior change trials.
尽管进行了精心规划和实施，但儿童及青少年超重/肥胖预防干预措施通常没有效果、效果不一致或效果微弱。此类项目通常旨在改变行为，很少也涉及环境变化，这些都是基于关于儿童超重/肥胖普遍公认的决定因素的传统观念。
本文评估了明显与超重/肥胖相关的决定因素——饮食、身体活动和压力的证据基础。在此背景下讨论了国际干预研究的结果。
基于中介调节变量模型，我们研究了理论规定的中介变量的影响以及潜在调节变量如何影响这些关系。
与普遍看法相反，最近的研究表明，关于潜在致胖行为与青少年超重/肥胖之间的关联，证据并不一致。此外，中介变量与目标行为之间存在强因果关系的证据似乎也不一致。此外，对调节效应的关注不足。
青少年超重/肥胖的病因可能是多种因果影响复杂相互作用的结果。未来的预防干预措施将受益于对已假设的复杂关系以及影响超重/肥胖的可疑行为机制有更透彻的理解。只有在现实世界环境中通过合理努力能够证明中介因素有实质性变化时，推进社区行为改变试验才有意义。
